MyPortfolioFix® Triage Form – MY PORTFOLIOFIX™

Portfolio Lagging? We Can Help!

Fast-tracked portfolio reviews for under-performing or broken investment accounts. No cost, no obligation, no minimums.

Triage

Please fill out the form below and locate a copy of the latest available statement for each account that you need help with. You can upload your statements at the end of the form or email them directly to triage@myportfoliofix.com

Once received, your assessment will usually be completed within 1-2 business days. Please be available for a phone appointment or two during this time.

First Name

Last Name

Phone

Are you over the age of 18?

Yes No

Address?

City

State

Zip

Country

Are you working or retired?

Working Retired

Occupation

Employer

Estimated pre-tax annual income

Are you currently dependent on income from this portfolio?

Yes No

How many accounts are you concerned about?

Total number of firms that hold these accounts?

How many of these are Retirement Accounts?

Estimated Total Value of Portfolio?

Estimated total loss in dollars?

When was your last in-depth portfolio review?

How often do you speak to your money manager?

Weekly Monthly Quarterly Yearly

What is the name of the firm this money manager works for?

Please input the highest value that you can remember for this portfolio?

Please input the lowest value that you can remember for this portfolio?

Please list the names or symbols of any current problem positions - stocks, funds, etc.

Please list the names of symbols of any current problem positions - stocks, funds, etc

Upload Previous Statements or Documents

Questions About MyPortfolioFix™?

IMPORTANT NOTICE REGARDING FUTURES TRADING: PAST PERFORMANCE IS NOT INDICATIVE OF FUTURE RESULTS OR SUCCESS. THE RISK OF LOSS IN COMMODITY FUTURES TRADING CAN BE SUBSTANTIAL. YOU SHOULD CAREFULLY CONSIDER WHETHER SUCH TRADING IS SUITABLE FOR YOU WITH REGARD TO YOUR FINANCIAL CONDITION. THE USE OF LEVER IN FUTURES CAN LEAD TO LARGE LOSESS AS WELL AS GAINS. PLEASE NOTE WE ONLY OFFER FUTURES TRADING TO QUALIFIED ELIGIBLE PERSONS AS DEFINED BY THE CFTC. FOR MORE INFORMATION, PLEASE READ OUR FULL DISCLAIMER. FURTHER, IT IS ASSUMED THAT BY VISITING OUR WEBSITE AND ENGAGING OUR FIRM YOU HAVE REVIEWED ALL APPLICABLE DISCLOSURES

PAST PERFORMANCE IS NOT NECESSARILY INDICATIVE OF FUTURE RESULTS. THE USE OF THE WORD “FIX” IN MYPORTFOLIOFIX™.COM DOES NOT IMPLY A GUARANTEED RATE OF RETURN. MYPORTFOLIOFIX™ AND JSPM, LLC ARE REGISTERED TRADENAMES OF JERSEY SHORE PORTFOLIO MANAGEMENT, LLC®

MYPORTFOLIOFIX.COM | LOCATED IN POINT PLEASANT, NEW JERSEY

Toll Free: 1.866.727.1532

help@myportfoliofix.com

Disclosure.

*MyPortfolioFix is a service of JSPMLLC a Registered Investment Advisor.

For immediate assistance, please fill out and send a copy of the triage form.